Pre-Referral Antibiotics and Mortality Among Adults With Sepsis in Southeast Asia: A Secondary Analysis of a Prospective Cohort Study
Issued Date
2026-01-01
Resource Type
eISSN
15300293
Scopus ID
2-s2.0-105026698733
Pubmed ID
41196125
Journal Title
Critical Care Medicine
Volume
54
Issue
1
Start Page
12
End Page
23
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care Medicine Vol.54 No.1 (2026) , 12-23
Suggested Citation
Coston T.D., Wright S.W., Hantrakun V., Rudd K.E., Chamnan P., Wongsuvan G., West T.E., Limmathurotsakul D. Pre-Referral Antibiotics and Mortality Among Adults With Sepsis in Southeast Asia: A Secondary Analysis of a Prospective Cohort Study. Critical Care Medicine Vol.54 No.1 (2026) , 12-23. 23. doi:10.1097/CCM.0000000000006932 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114680
Title
Pre-Referral Antibiotics and Mortality Among Adults With Sepsis in Southeast Asia: A Secondary Analysis of a Prospective Cohort Study
Author's Affiliation
University of Washington
University of Pittsburgh School of Medicine
University of Washington School of Medicine
Nuffield Department of Medicine
Faculty of Tropical Medicine, Mahidol University
Faculty of Medicine, Chulalongkorn University
Mahidol Oxford Tropical Medicine Research Unit
Sunpasitthiprasong Hospital
University of Pittsburgh School of Medicine
University of Washington School of Medicine
Nuffield Department of Medicine
Faculty of Tropical Medicine, Mahidol University
Faculty of Medicine, Chulalongkorn University
Mahidol Oxford Tropical Medicine Research Unit
Sunpasitthiprasong Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
OBJECTIVE: Early antibiotics are considered critical for bacterial sepsis treatment, although the benefit of this early timing may differ by the presence of shock. Little evidence exists from low- or middle-income settings. In patients referred from community hospitals to a tertiary center, we tested whether pre-referral antibiotic administration is associated with 28-day survival in sepsis, and whether this association differs by the presence of shock. DESIGN: Secondary analysis of a prospective cohort study that enrolled patients from 2013 to 2017 with a primary diagnosis of infection made by an attending physician and at least three Surviving Sepsis Campaign criteria for sepsis. SETTING: Tertiary care hospital in northeastern Thailand. PATIENTS: A total of 2593 adults with sepsis defined by primary diagnosis of infection and modified Sequential Organ Failure Assessment score greater than or equal to 2 who were referred from community hospitals. INTERVENTIONS: Antibiotics administered at the referring community hospital. MEASUREMENTS AND MAIN RESULTS: The median age was 59 years (interquartile range 44-72), 2233 (86.1%) were transferred the same day as initial presentation, and 1897 (73.2%) received antibiotics prior to referral. Blood cultures grew bacteria in 313 (12.1%). Twenty-eight-day mortality was 18.9%. In the propensity score-matched cohort ( n = 722 sepsis without shock, n = 244 septic shock), shock modified the association between pre-referral antibiotics and death (interaction p = 0.001). In patients with septic shock, pre-referral antibiotics were associated with lower hazard of death (hazard ratio [HR], 0.38; 95% CI, 0.19-0.75) but in patients without shock there was no association with hazard of death (HR, 1.36; 95% CI, 0.96-1.92). CONCLUSIONS: In rural Thailand, antibiotic administration prior to referral was associated with lower hazard of death in patients with septic shock. Our findings extend to a resource-limited setting evidence supporting the benefit of early antibiotic administration in septic patients with shock.